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The Perioperative Impact of Concomitant Procedures during Open Infrarenal Abdominal Aortic Aneurysm Repair
Klaas H. Ultee1, Peter A. Soden, MD1, Sara L. Zettervall, MD, MPH1, John C. McCallum, MD, MPH1, Jeffrey J. Siracuse, MD2, Matthew J. Alef, MD3, Hence JM Verhagen, MD, PhD4, Marc L. Schermerhorn, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Boston University School of Medicine, Boston, MA, USA, 3The University of Vermont Medical Center and University of Vermont College of Medicine, Burlington, VT, USA, 4Erasmus Medical Center, Rotterdam, Netherlands.
OBJECTIVES:
Open repair of abdominal aortic aneurysms (AAA) is occasionally performed in conjunction with additional procedures. However, it is unclear how these concomitant procedures affect outcome. This study aims to determine the frequency of additional procedures during elective open AAA repair and the impact on perioperative outcomes.
METHODS:
Between January 2003 and November 2014, all elective infrarenal open AAA repairs in the Vascular Study Group of New England (VSGNE) were identified. Patients were grouped by concomitant procedures, which included: no concomitant procedure, renal artery bypass, lower extremity bypass, other abdominal procedure or thrombo-embolectomy. Analyses were performed using multivariable logistic regression.
RESULTS:
1314 patients underwent elective AAA repair, of whom 153 (11.6%) had a concomitant procedure, including renal bypass 27 (2.1%), lower extremity bypass 28 (2.1%), other abdominal procedures 64 (4.9%), and thrombo-embolectomy 48 (3.7%). Independent risk factors for 30-day mortality were renal bypass (OR: 7.2, 95% CI: 1.9 - 27.7), other abdominal procedures (OR: 4.8, 95% CI: 1.6-14.1) and thrombo-embolectomy (OR: 8.8, 95% CI: 3.1-24.9). Deterioration of renal function was predicted by renal bypass (OR: 5.1, 95% CI: 2.1-12.4) and thrombo-embolectomy (OR: 3.7, 95% CI: 1.8-7.6). Lower extremity bypass and thrombo-embolectomy were predictive of postoperative leg ischemia (OR: 8.9, 95% CI: 2.7-29.0; OR: 11.2, 95% CI: 4.4-28.8, respectively), while thrombo-embolectomy was also predictive of postoperative myocardial infarction (OR: 4.4, 95% CI: 1.6-12.0).
CONCLUSIONS:
Performing additional procedures during infrarenal open AAA repair is associated with increased morbidity and mortality in the postoperative period. Careful deliberation of both the operative risks and the necessity of the additional interventions are therefore advised during operative planning. This study also highlights the importance of avoiding perioperative thrombo-embolic events.
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